Biomedical subjects
Publications and source records attributed to J Auque.
The authors report two cases of intracranial, extradural, intracavernous epidermoid cyst. In one case the cyst was ruptured into the subarachnoid space and in the substance of the temporal lobe. The two cysts had to be subtotally resected because of dense adherences with the internal carotid artery. In both cases the post-operative periods were uneventful.
Fifty four patients (33 male and 21 female, mean age 47) with spontaneous aneurysmal subarachnoid hemorrhages have been tested by repeated TCD: 25 of them were systematically administered intravenous Nimodipine when admitted at hospital, the 29 others constituted a reference group. There was no statistically significant difference between the two groups of patients for age, sex, initial clinical status, importance of bleeding at CT scan, localization of aneurysm or existence of an angiospasm, whether clinically symptomatic or not. In 72% of the cases, TCD allowed to prove the existence of an angiospasm when higher flow velocity was registered in cranial basal arteries. There was no significant difference between the two groups. The final clinical status of the patients seemed to be more favourable in the treated group. Yet it did not appear to be directly linked to the existence of a spasm or not. This argued in favour of a non-univocal mechanism of action of Nimodipine.
Thirty four cases (18 operated, 16 non-operated), of cavernous angioma are reported. The presenting symptoms and signs were epilepsy in 22 cases, neurologic deficit in 9 and cerebromeningeal hemorrhage without vigilance disorders in 3. In the operated group 15 angiomas were supratentorial, 3 were subtentorial. In the non-operated group symptoms and signs were epilepsy in 11 cases and a neurologic deficit related to a brain stem lesion in 4/5 cases. Follow-up of 2 to 39 years after the first fit episode and of 1 to 7 years after initial diagnosis suggested that the risk of hemorrhage is low. Indications for neurosurgery are discussed as a function of the site of the angiomas and of the operative hemorrhagic risk.
The authors report two cases of low back pains with sciatica caused by a synovial cyst of the interapophyseal joint of the lumbar spine. Analysis of only 23 cases found in the literature, point to their rarity, the lack of specific clinical signs, the importance of the CT scan for the diagnosis and the excellent results of surgical treatment.
Lumbar disc herniation in young adolescent is uncommon. Twelve patients of 13 to 16 years old (4 boys and 8 girls) are reported. Traumatic history is encountered only in 1/3 of cases and any spinal abnormality is noted in this series. The rapidity in clinical course is the main difference compared with the lumbosciatalgia of the adult. The mean interval of time between the beginning of clinical signs and surgery is 5 months and a half. A positive straight leg raising test is always present as well as antalgic pseudo-scoliosis. The radiculalgia without lumbalgia is the essential sign in on fourth of cases. The myelography and C.T. scan revealed lumbar disc herniation 5 times in L4-L5 intervertebral space and 7 times in L5-S1 space. The intervertebral disc is reached by unilateral interlaminal approach. The complete removal of the disc is always difficult as the disc is not dehydrated at this age. The radiculalgia disappears immediately in the postoperative period as well as the lumbalgia. The back pain persist some months following the surgery. Up the date any response is noted but the authors think that some prudence is necessary in the evaluation of the results especially because of the incomplete removal of disc in young patients. The authors think also that well hydrated and simply protruded disc of young adolescent may constitute an excellent indication for chemonucleolysis.
The authors report a recent case of massive and immediate epistaxis resulting from a rupture of the internal intracavernous carotid artery caused by closed head injury. The point out the unusualness and the extreme severity of such lesions. The pathogenesis of these epistaxis can be explained by an immediate arterial rupture proceeding from a sphenoidal fracture. The emergency bilateral carotid angiography states precisely the diagnosis and the level of the rupture, allowing in the same time the intravascular treatment by detachable balloon.
An early treatment and an adequate antimicrobial chemotherapy are major prognostic factors for bacterial meningitis, brain abscesses and related infections. The necessity of an early therapy requires to begin an empiric antibiotic treatment prior to obtain microbiological results. The principles that apply to empiric therapy of other types of infections are equally applicable to the treatment of central nervous system (CNS) infections and include: the capacity of achieving adequate levels of antibiotic in the CNS and for the brain (pharmacokinetic criteria), the knowledge of the most likely etiologic agents for central nervous system infections and their antibiotic susceptibility (bacteriological criteria). The main clinical types of CNS infection are reviewed for their usual etiologic agents, with a definition of an optimal "bacteriological deal" for each situation. Most studies emphasize the striking differences in the clinical features, etiologic agents and prognosis of spontaneously occurring (primary) meningitis, as opposed to post-traumatic or post-surgical, frequently Gram negative bacillary (secondary) meningitis and other CNS infections (brain abscesses and related infections). These studies, as our experience, suggest that the selection of an empiric therapy must be adapted for each clinical situation. Ampicillin still appears to be an ideal agent for empiric therapy for primary meningitis in older children and adults, in whom meningitis are usually caused by N. meningitidis and S. pneumoniae. In younger children (before 6 years), H. influenzae is more often implicated and the occurrence of beta lactamase mediated resistance to ampicillin in as high as 15% of isolates led to use a third generation cephalosporin as an empiric therapy. Neonatal meningitis, meningitis following trauma or surgery, brain abscess, subdural empyema, epidural abscess are caused by various etiologic agents including Streptococcus sp, Staphylococcus sp, Enterobacteriaceae, and for brain infections, anaerobic bacteria. Each situation led to specific recommendations by authors. Finally, miscellaneous aspects of therapy as the usefulness of intrathecal or intraventricular therapy, duration of treatment and place of the neuro-surgery during CNS infections are briefly reviewed.
Through a study of some syndromes of intra-cranial high and low pressure, the authors try to find out the relations between the intra-cranial stresses and the development of frontal sinuses. They account for the choice of frontal sinuses and the various factors determining this pneumatization. They study the morphology of the frontal sinuses in 20 cases of old and chronic hydrocephaly, in 13 cases of oxycephaly with a late diagnosis, and in 20 cases of adults suffering with infantile cerebral hemiatrophy. They show that in these syndromes, the development of frontal sinuses is an inverse ratio to the intracranial pressure. However, they point out that in standard people, the extreme differences in the morphology of their frontal pneumatization can be explained not only by various causes--a number of which is as yet not known--but also by an aleatory distribution.
Seven patients with unilateral arterial carotid occlusion and contralateral arterial carotid stenosis in the neck are reported. Authors perform an extra-cranial to intra-cranial anastomosis on the occluded side prior to realize endarterectomy on the stenosed side. This policy obviates the need of an internal vascular shunt during temporary occlusion of I.C.A.
The authors compare the results of carotid artery back pressure and EEG monitoring in 100 carotid endarterectomies. They point out that EEG, especially during operative carotid occlusion, is more reliable to detect cerebral ischemia. EEG monitoring permits also to avoid using shunt more frequently.
Nosologic concepts distinguish three types of aneurysm of Galen's ampulla: true aneurysms, related aneurysms, false aneurysms, whatever the type the majority of these malformations can be treated by the endovascular approach, frequently the most effective alternative therapy. Experience acquired during treatment of intracerebral arteriovenous angioma allows perfect control of direct, high output arteriovenous fistula by injection of pure isobutyl cyanoacrylate. Occlusion of shunts should be combined with prevention of consequences, that is to say extensive venous thrombosis. Two cases are reported that demonstrate the value of post-embolization heparin therapy.
Explore the source record for details and available documents.
A case of delayed respiratory depression following an intrathecal injection of hyperbaric morphine hydrochloride is reported. This injection was made during a lumbar myelography in a 60 year old patient suffering from metastatic epiduritis unrelieved by oral or parenteral drugs. The differences in densities between the CSF, hyperbaric opiate solution and contrast medium explain the migration of the morphine hydrochloride from the lumbar thecal space to the basal cisternae, giving a fall in the responsiveness to CO2 of the brain stem respiratory centres. Parenteral naloxone did not reverse this ventilatory depression. Only the myosis and the analgesia disappeared. After 16 h of various attempts of reversal by parenteral injections, an intrathecal injection of naloxone was tried. This small dose (0.1 mg), given intrathecally, resulted in a prompt return to normal of respiratory function.
Explore the source record for details and available documents.
The authors report a recent series of 12 intra-cranial epidermoid and dermoid cysts. After they had reminded the main classical radiological and clinical signs which are rarely specific, they study C.T. scan semiology which at present and in most cases permits to base an undoubted diagnosis.
Authors point out three observations of spontaneous dissection of cervical internal carotid artery (I.C.A.) with various evolution. They emphasize on evolutivity of residual aneurysms and necessity to purpose a preventive treatment of secondary projections.
The spinal osteochondroma has been studied in 4 personal cases. This benign tumor unfrequently develops on the spine and even less insolitary. In the 4 cases reported, the sites of the tumor were thoracic (2 cases) cervical (1 case), cervicothoracic (2 cases) which are most frequently mentioned in publications. The tumors were located either on the "posterior arc" either on the "antero-lateral" region of the vertebral body on the level of the "costo-transversary" angle. The clinical manifestations were a growth of a tumefaction, spinal pain and sometimes radicular or medullary neurological signs. The X-Ray image is evident. The best diagnostic procedure is C.T. Scan which determines the exact position and size of the tumor. Surgery is the best treatment. The excision must be large and the pedicule totally removed in order to avoid recurrence. This occurred in one of the cases reported. The osteochondroma becomes rarely malignant. If the tumor involves several spinal segments, post-operative X-Ray investigations must be done for a long period in order to watch out for recurrence.
Authors describe their own experience of Sundaresan anterior approach and exposure of the upper thoracic vertebrae (T1-T2) including resection of the internal third of the clavicle and manubrium sterni. They point out technical details of that surgical approach and its indications.